PART 1 Special risks groups - Pregnancy Flashcards

1
Q

During pregnancy, most drugs can ____ and _____.

A

Cross the placenta and expose the baby to their effects.

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2
Q

Factors affecting placental drug transfer and drug effects on the fetus

A
  • Drug physiochemical properties.
  • Duration of drug exposure.
  • Distribution in different fetal tissues.
  • Stage of placental and fetal development.
  • Effects of drugs used in combination.
  • Rate at which drug crosses placenta and amount reaching fetus.
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3
Q

Pharmacokinetic changes in GASTROINTESTINAL ABSORPTION

A
  • Decreased GI motility and reduction in gastric acid secretion.
  • Increase in gastric pH, therefore negatively affects drugs that require acidic pH for absorption.
  • Nausea and vomiting
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4
Q

Pharmacokinetic changes in LUNG ABSORPTION

A
  • Cardiac and tidal volumes increase by approx. 50% in pregnancy.
  • Hyperventilation and increased pulmonary blood flow.
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5
Q

Pharmacokinetic changes in TRANSDERMAL ABSORPTION

A
  • Vasodilatation leads to increased tissue perfusion.

- Absorption on IM administration is highly effective.

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6
Q

Factors affecting DRUG ABSORPTION in Pregnancy.

Hint - LMP

A
  • Lipid solubility
  • Molecular size
  • pH
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7
Q

Lipid solubility factor

A
  • Lipid soluble drugs (e.g. Thiopental) easily diffuse across the placenta.
  • Impermeability of the placenta to polar compounds is relative rather than absolute (whole thing).
    • That’s if high enough maternal-fetal concentration gradients are achieved, polar compounds cross the placenta in measurable amounts (e.g. Salicylate).
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8
Q

Molecular size factor

A
  • Influences the rate of transfer and amount of transfer.
  • Drugs having molecular weight:
    A. 250-500 cross easily.
    B. 500-1000 cross with more difficulty.
    C. >1000 cross very poorly.
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9
Q

Factors affecting DRUG DISTRIBUTION in pregnancy.

A
  • Protein binding
  • Body fat
  • Total body water
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10
Q

Total body water factor

A

Total body water increases due to hemodilution, so large volume of distribution for water soluble drugs.

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11
Q

Total body water factor

A

Total body water increases due to hemodilution, so large volume of distribution for water soluble drugs.

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12
Q

Body fat factor

A
  • Body fat is increased and acts as a reservoir for lipid soluble drugs.
  • These lipid soluble drugs can increase and accumulate in body fat, causing toxicity.
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13
Q

Factors affecting DRUG METABOLISM in pregnancy

A
  • Blood flow (cardiac output)

- Hepatic clearance

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14
Q

Blood flow factor

A

Hepatic metabolism is increased through blood flow to liver.

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15
Q

Hepatic clearance factor

A
  • Hepatic clearance = ability of the liver to extract and metabolize a drug as it passes through the liver.
  • Drugs metabolized by the liver have increased clearance.
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16
Q

Factors affecting DRUG ELIMINATION in pregnancy

A
  • Renal blood flow

- Glomerular Filtration rate

17
Q

Renal blood flow factor

A

Is increased or doubled; therefore there is rapid elimination of drugs excreted by the kidneys.

18
Q

Glomerular Filtration rate factor

A
  • Is increased….
19
Q

3 things determine the magnitude and seriousness of a drug on fetal development

A
  1. Fetal age
  2. Drug dosage
  3. Potency
20
Q

Drug use during lactation

A
  • Most drugs are detectable in breast milk.

- Concentrations are usually low, preventing infants from receiving therapeutic amounts.

21
Q

Recommendations for feeding mothers

A
  • Take safe drug 30-60 mins after nursing and 3-4 hrs before next feeding.
  • Avoid usage of toxic drugs or discontinue breast feeding.
22
Q

TETRACYCLINE effects on infants during lactation

A

Risk of permanent tooth staining in infant.

23
Q

ISONIAZID effects on infants during lactation

A

Risk of pyridoxine deficiency in the infant.

24
Q

BARBITURATES effects on infants during lactation

A

Lethargy, sedation and poor suck reflexes.

25
Q

IODINE effects on infants during lactation

A

Thyroid suppression and risk of cancer.

26
Q

DIAZEPAM effects on infants during lactation

A

Drug accumulation and sedation.

27
Q

CHLORAL HYDRATE effects on infants during lactation

A

Drowsiness if infant is fed at peak.

28
Q

Therapeutic effect of drugs on fetus
- EXAMPLES

Drugs are administered to pregnant women targeting fetus.

A
  • Corticosteroids = used for lung maturation.
  • Phenobarbitone = prevents neonatal jaundice.
  • Zidovudine or Nevirapine = inhibits transmission of AIDS to fetus from mother.
29
Q

Predictable toxic effect of drugs on fetus

- EXAMPLES

A
  • Opioids = respiratory depression.
  • ACE inhibitors = congenital anomalies.
  • Diethylstilbestrol = vaginal carcinoma in female offspring after puberty.
30
Q

Describe a Teratogen

A
  • Any drug or substance that produces characteristic sites of malformation with selectivity for certain organs.
  • Also exerts its effect at a particular stage of fetal development.

(An agent or factor which causes malformation of an embryo)

31
Q

Examples of malformations a teratogen causes

A

Clubfoot, neural tubal defects, missing or malformed limbs etc.

32
Q

What happens when there is continuous exposure to a teratogen?

A

May produce cumulative effect or may affect multiple organs which are undergoing development.
E.g. Facial abnormalities

33
Q

Drugs that treat CONSTIPATION

common problems in pregnancy & safe drugs

A

Mild purgative like Senna

34
Q

Drugs that treat URINARY TRACT INFECTIONS (UTIs)

common problems in pregnancy & safe drugs

A
  • Ampicillin
  • Amoxycillin
  • Cefuroxime axetil
35
Q

Drugs that treat PEPTIC ULCER

common problems in pregnancy & safe drugs

A
  • Sucralfate

- H2 blockers

36
Q

Drugs that treat NAUSEA & VOMITING

common problems in pregnancy & safe drugs

A
  • Pyridoxine

- Meclizine diphenhydramine

37
Q

Drugs that treat MALARIA

common problems in pregnancy & safe drugs

A
  • Chloroquine
  • Quinine
  • Proguanil
38
Q

Drugs that treat HIV INFECTION

common problems in pregnancy & safe drugs

A
  • Zidovudine

- Nevirapine

39
Q

Drugs that treat EPILEPSY

common problems in pregnancy & safe drugs

A

Must be used in lower dose:

  • Sodium valproate
  • Carbamazepine